Pediatric CHD Preop Assessment

Based on AHA Scientific Statement 2023

Risk Stratification Score

Select all factors that apply. Score predicts 30-day mortality risk derived from Faraoni et al.

Total Score

0
Risk Category
Low Risk
Mortality Odds Ratio
1.54x
Compared to baseline

Quick Actions

ACS-NSQIP CHD Classification

Use this guide to determine if the patient falls into the "Severe CHD" category for the risk calculator.

Minor CHD

Cardiac condition with or without medication and maintenance.

Examples
  • • Atrial Septal Defect (ASD)
  • • Small to moderate VSD (no symptoms)
  • • Repaired CHD (normal function)
Major CHD

Repair of CHD with residual hemodynamic abnormality with or without medications.

Examples
  • • TOF with pulmonary regurgitation
  • • HLHS Stage 1 palliation
  • • Repaired complex lesions with residuals
Severe CHD

Uncorrected or decompensated physiology.

Examples
  • • Uncorrected cyanotic CHD
  • • Pulmonary Hypertension
  • • Ventricular dysfunction (on meds)
  • • Listed for transplant

Preoperative Assessment Checklist

Ensure all physiological systems are evaluated prior to induction.

Management Flowchart

Emergency Procedure?

Yes: Consult peds cardiac anesthesia immediately. Proceed regardless of status.
No: Proceed to Risk Assessment.

Assess Cardiac Classification

Determine if lesion is Minor, Major, or Severe/Single Ventricle.

Calculate Risk Score

Use the Risk Calculator tab to sum points for: Emergency, Severity, SVP, Recent Surgery, Inotropes, CPR, AKI, Mech Vent.

Score ≤ 3 (Low Risk)

  • Consider consultation with peds cardiac anesthesia
  • No ICU bed strictly needed based on lesion
  • Outpatient surgery possible

Score > 3 (High Risk)

  • Peds Cardiac Anesthesiologist care recommended
  • Center with ICU bed availability
  • Multidisciplinary discussion required
  • Potential ECMO backup discussion